| Comparative study of CT guided puncture and endoscopic ultrasound biopsy in pancreatic neoplastic lesionsObjective:To compare the sensitivity,specificity,negative and positive predictive value,material score and incidence of complications between computed tomography(CT)guided puncture and endoscopic ultrasonography in pancreatic neoplastic biopsy.The purpose is to investigate the accuracy,safety and material adequacy of CT-guided rotary cutting and negative pressure aspiration technique for needle biopsy of pancreatic neoplastic lesions.Methods:The data of 98 patients with pancreatic tumor underwent CT guided puncture or endoscopic ultrasound biopsy for pathological diagnosis were retrospectively analyzed from October 2016 to October 2019.There were 40 cases in CT guided pancreatic tumor biopsy group and 58 cases in EUS guided pancreatic tumor biopsy group.The counting data were expressed as percentage(%).Chi square test or Fisher’s exact test was used for comparison between groups and within groups.The measurement data were expressed as mean±standard deviation(χ±SD).Two independent samples t test or Wilcoxon rank sum test were used for comparison.p<0.05 indicated that the difference was significant.Results:The sensitivity,specificity,negative and positive predictive value and accuracy of CT guided biopsy of pancreatic tumor were 85.0%(34/38),100%(2/2),33.3%(2/6),100%(34/34)and 90.0%(36/40),respectively.The sensitivity,specificity,positive and negative predictive value and accuracy of EUS guided biopsy were 90.57%(48/53),100%(5/5),50%(5/10),100%(48/48)and 91.38%(53/58),respectively.There was no significant difference between 91.38%(53/58)accuracy in EUS-FNA group and 90.0%(36/40)accuracy in CT-PNB group(χ2=0.0535,p=0.817).The CT-PNB group obtained 90.0%(36/40)of 5-score material specimens,which was significantly higher than 72.4%(42/58)of 5-score material specimens in EUS-FNA group(p=0.034).The materials with 5 points in CT-PNB group and EUS-FNA group were significantly higher than those with<5 points,with statistical significance(p<0.05).Ninety-eight patients in both groups achieved technical success without major complications such as massive hemorrhage,abdominal infection,pancreatic fistula and intestinal fistula.The incidence of secondary complications was 10.2%(10/98),and the main manifestations were small or self-limited bleeding at the puncture site,acute pancreatitis,etc.There were 5 cases(12.5%,5/40)of small or self-limited bleeding in CT-PNB group and 2 cases(3.45%,2/58)in EUS-FNA group,respectively,with statistical significance(p=0.190).There was 1 case(1.72%,1/58)of acute pancreatitis in CT-PNB group and 2 cases(5.0%,2/40)in EUS-FNA group,respectively,and the difference was not statistically significant(p=0.742).There was no statistical significance in the complication rate of 17.5%(7/40)in the CT-PNB group and 5.17%(3/58)in the EUS-FNA group(p=0.101).Follow-up observation of patients in both groups was no less than half a year,and no tumor implantation metastasis was observed in either group.Conclusion:1.Both CT-PNB and EUS-FNA can obtain satisfactory pathological diagnosis specimens in pancreatic tumor lesions with low incidence of complications,which are minimally invasive,safe and effective biopsy methods.2.The CT-PNB group had a higher score of 5 than the EUS-FNA group,which was superior to EUS-FNA group in the adequacy of biopsy materials.Clinical study of CT-guided 125I seed implantation in the treatment of pain in unresectable pancreatic cancerObjective:To investigate the efficacy of CT guided interstitial brachytherapy with 125I seeds(CTRISI)in the treatment of unresectable pancreatic cancer pain and its relationship with the expression of miR-7-5p in cancer tissue,and to predict the main regulatory pathways involved in miR-7-5p target gene.Methods:Forty-five patients with unresectable pancreatic cancer pain were included,of whom 4 were unable to undergo surgery and 4 were lost to follow-up.Thirty-seven patients completed ctrisi according to the treatment plan and obtained complete follow-up data.SPSS20.0 software was used for data statistical analysis.Continuous variable data were expressed as mean±standard deviation(χ±SD),and enumeration data were expressed as frequency and percentage.Univariate repeated-measure ANOVA and paired t-test were used to compare pain scores and analgesic dosage before and after treatment.Survival curves were plotted by Kaplan-Meier analysis.Cancerous tissue miR-7-5p relative expression using 2-ΔΔCt value measure,divided into high and low level group,χ2 test was used for comparison between groups.Allp values were bidirectional and p<0.05 was considered to be significant.Bioinformatics software and online tools were used to predict miR-7-5p target genes,construct networks and analyze enrichment pathways.Results:CT-guided radioactive 125I seed implantation was successfully completed in all patients.Before 125I seed implantation,there were 12 cases of mild pain(NRS≤3),24 cases of moderate pain(4≤NRS≤6)and 1 case of severe pain(NRS≥7).One week after 125I seed implantation,one patient’s pain was completely relieved,23 patients’ pain were relieved at least 50%,and the other 13 patients’ pain were not improved.Compared with preoperation,no pain and mild pain after one week(94.6%,35/37)were significantly higher than preoperation(32.4%,12/37).One month after operation,2 patients had complete pain relief,20 patients had pain relief of at least 50%,and the other 15 patients had no pain improvement.Compared with preoperative,no pain and mild pain(86.5%,32/37)were significantly higher than preoperative(32.4%,12/37).Two months after operation,there were no NRS=0,21 cases with NRS≤3,16 cases with 4≤NRS≤6,and 0 cases with NRS>7.Compared with preoperative,NRS≤3(56.8%,21/37)was also significantly higher than preoperative(32.4%,12/37).The pain relief rates at 1 week,1 month and 2 months after 125I seed implantation were 67.6%(25/3 7),59.5%(22/37)and 27.0%(10/37),respectively,and the NRS scores after implantation were significantly lower than those before implantation(p<0.05).The daily doses of Oxycodone sustained-release tablets at 1 week and 1 month after implantation were 42.2±20.7mg and 26.2±15.7mg,respectively,which were significantly lower than those before implantation(62.2±22.0mg,p<0.001).However,the daily dose of Oxycodone sustained-release tablets of 60.3±25.7mg at 2 months after implantation was no significant difference compared with preoperation(p=0.198).The median survival time of pancreatic cancer lesions ≤5cm and>5cm were 6.2±0.794 and 5.1±0.543 months,respectively,with statistical significance(F=2.305,p=0.038,95%CI:4.036-6.164).The objective response rate(ORR)was 65.0%(13/20)in 13 of 20 patients with high miR-7-5p expression.Among the 17 patients with low miR-7-5p expression,only l case reached PR,and the ORR was 5.88%(1/17).The difference between the two groups was significant(χ2=13.654,p<0.001).The high expression of miR-7-5p radiotherapy was relatively sensitive with high objective response rate,while the low expression of miR-7-5p radiotherapy was relatively insensitive with low objective response rate.No serious complications occurred in all patients.The median survival time was 5 months after 1 year of follow-up.Bioinformatics predicted that miR-7-5p and target genes PIGH、EGFR、EGFR、NXT2、PIK3CD、PIK3R3、ERBB4、TRMT13、C5ORF22 constituted a network module,and its core genes RAF1、EGFR、PIK3CD and PIK3R3.Conclusion:Spiral CT-guided 125I seed implantation can effectively relieve the pain of unresectable pancreatic cancer,reduce the amount of analgesic drugs,and improve the quality of life of patients.In particular,the high expression of miR-7-5p in cancer tissues and lesions ≤5cm showed significant curative effect.Several genes targeted by miR-7-5p may be involved in the regulatory pathway of pancreatic cancer radiosensitivity,especially RAF1、EGFR、PIK3 CD and PIK3R3 genes may play a leading role in the regulation. |
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